This application for the K24 midcareer mentoring award in patient-oriented research is organized into 3 sections. In the first section, I describe my history of conducting patient-oriented research in 2 major areas: pediatric psychology and adolescent suicide. I have conducted research in the areas of pediatric asthma, sleep disorders, cancer, cystic fibrosis and developed a brief measure of coping which is widely used. I have also had a number of state, private, and federal grants to study the behavioral and psychological characteristics of adolescent suicide attempters. The last few years this programmatic research has been focused on how to improve treatment compliance and use structured treatment protocols for this high risk population. My career objectives are to conduct treatment research with high risk adolescent populations; in particular, adolescents with suicidal behavior and substance abuse problems. This award will contribute to my career objectives by relieving me of patient care duties and providing the time for additional training in substance abuse treatment. Opportunities for memorizing, which are ample due to Brown's strong postdoctoral training programs, are described in the second section. Three junior faculty are specifically identified to work under me on the proposed research project: a comprehensive, integrated, theoretically-based treatment protocol for the most high risk group of suicide attempters with comorbid substance abuse. In addition, two postdoctoral fellows will also work on this comprehensive intervention. In section three, the treatment program is presented. The premise of this protocol is that these high risk adolescents with comorbid substance abuse and suicidal behavior need multiple training opportunities in different circumstances - individual and family - to be able to effectively develop and positively appraise their problem-solving and affect management skills. An individual 14 session therapy protocol focusing on problem-solving and affect management is complemented by a 14 session family therapy protocol. These sessions will be conducted at the clinic or in home-based sessions. Similar skills are emphasized in both the individual and family sessions to reinforce skill retention. A substance use treatment protocol will be developed in the first 18 months of this application, piloted for an additional 6 months, and then integrated into the comprehensive treatment protocol. This integrated substance abuse/suicidal behavior treatment protocol will then be compared to the standard treatment protocol in a group of 50 adolescents with comorbid substance abuse/dependence and psychiatric symptomatology, including suicidal behavior, with outcome assessed at 6 and 12 month follow-up.